Provider First Line Business Practice Location Address:
725 N 15TH ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-336-7472
Provider Business Practice Location Address Fax Number:
610-336-7473
Provider Enumeration Date:
01/13/2011